Changing the Verb of Homelessness

"If good intentions, well-meaning programs and humanitarian gestures could end homelessness, it would have been history decades ago."-- Philip Mangano, Executive Director, United States Interagency Council on Homelessness

Of all the shortcomings of the Bush presidency, perhaps none was as frustrating to conservatives as its poor communications strategy. The problem wasn't just the administration's habit of announcing policies without sufficiently explaining them, or its failure to defend unpopular policies. Most discouraging was its reluctance to talk about policies that proved wildly successful.

Last week, the president's office of Faith-Based and Community Initiatives released a report called "Innovations in Compassion." The report highlights some of the triumphs of the much-maligned agency, among which is this gem: a nearly one-third decrease in chronic homelessness between 2005 and 2007.

The man most responsible for the precipitous drop in homelessness is Philip Mangano, executive director of the U.S. Interagency Council on Homelessness. In a recent interview, Mangano talked to me about the secret to his success, which is rooted in his mission "to change the verb of homelessness. After 20 years of managing the crisis, our intent was ending the disgrace."

This small shift in emphasis has produced great results. Besides the 30 percent decrease in chronic homelessness (defined as homelessness of at least one year of a person with serious mental illness and/or drug or alcohol addiction), there was a 12 percent reduction in overall homelessness nationally (from 763,000 to 672,000). Also, there was an almost 40 percent decrease in the number of homeless veterans between 2001 and 2007.

In order to move from managing homelessness to ending it, Mangano recognized the need for his agency to get rid of the old strategies. Under President Clinton, funding was tripled for programs to decrease homelessness, but the number of homeless only increased. "We had been busy servicing homeless people," Mangano says, "spending more money without any results."

So when he was appointed by President Bush to lead the council in 2002, Mangano and his team implemented an approach to homelessness that was entirely appropriate for the administration of the first president with an MBA. "For many years," Mangano says, "the issue of homelessness was driven by anecdote, conjecture, guess work and feeling." But with Mangano at the helm, the touchy-feelyness was replaced by a results-oriented business approach rooted in evidence and data.

And, predictably, the evidence showed that moving chronically homeless people into housing units was the only reliable way to end chronic homelessness.

The council's "housing first" strategy was truly an innovation in compassion. But it also sounded expensive. And the seven consecutive years of record resources targeted to homeless people (this year's budget includes an unprecedented eighth year of record resources for homelessness) might make fiscal conservatives wince. But Mangano's position is: What's cheaper: putting homeless people in homes, or letting them cycle through shelters, hospital emergency rooms, jails and the street?

He says, "We discovered through our research that these are some of the most expensive people to the public purse, randomly ricocheting through very expensive primary health, behavioral health, law enforcement and court systems." The results of 65 cost studies revealed that the true costs of chronic homelessness are staggering, between $35,000 and $150,000 a year per person.

Consider these examples.

• Boston Health Care for the Homeless Program tracked 119 persons who were chronically homeless for 5 years and found that they made more than 18,000 emergency room visits at an average cost of $1000 per visit.

• One study found two homeless men in Reno cost the city over $100,000 each in health and law enforcement in one year.

• The University of California at San Diego followed 15 chronically homeless street people for 18 months and found that they cost the city $200,000 per person. As one official put it, "We could have placed them in condos with ocean front views for less."

Contrast those numbers with the annual cost of supportive housing for homeless people, which runs between $13,000 and $25,000 per year, per person. And, importantly, once homeless people have homes, the expense is reduced further as they build new lives and address the costly correlates of homelessness, such as mental illness, substance abuse and corrections. In Mangano's words, "A place to live is most likely to create a trajectory out of dependence, toward self-sufficiency."

The net cost savings to taxpayers is significant. In one example in Portland, Oregon, 35 homeless individuals were placed in housing. The pre-enrollment health care and incarceration costs per person, per year were $42,075. The post enrollment cost averaged $25,776. That translates into an annual cost savings $16,299 per person.

Mangano's success in reducing homelessness demonstrates the transformative power of faith-based initiatives. It also begs the question: Will Mangano and his innovative approach to homelessness find a place in the Obama White House? Mangano is unsure what will happen. Although his work has drawn praise from across the political spectrum, Mangano says there will always be "nostalgia for the old approaches."

At one point during his Inaugural Address, President Obama, directing his remarks to "the cynics," implied that bipartisanship will now be the order of the day, noting:

"The question we ask today is not whether our government is too big or too small, but whether it works -- whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward."

At a time when job losses and record foreclosures threaten to slow progress in ending homelessness, preserving the Bush administration's results-oriented, housing-first strategy to combat homelessness is a way Obama can prove the cynics wrong.

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